Epilepsy Talk

Hidden hospital bill gouging…gone! | January 30, 2022

In April 2017, a man named Drew Calver thought he was dying. A heart attack had pinned him to the floor of his bedroom. His neighbor took him to St. David’s Medical Center in Austin, where he was successfully treated. Weeks later, he received a bill from the hospital: That’ll be $108,951.31, please. St. David’s was out of network on his insurance, and Aetna had only paid $55,840 of the total $164,941 bill for his treatment. 

When Andrew Heymann helped his friend move two years ago, a glass table shattered and cut open Heymann’s left ankle. An ambulance rushed him to a nearby hospital, which he knew was in-network. But after a plastic surgeon stitched up the wound, Heymann was surprised to receive a bill for nearly $6,000. His insurance initially covered just $860 of the charges.

Michael went to a 30-day rehab a while back, it was covered completely. When he finished the program the asked him to attend outpatient which again they told him was covered, not even a copay. Years later, he had a $40,000 medical bill on his credit report and had no idea of how to deal with it. So much for buying a house.

But there’s good news on the horizon:

A New Ban on Surprise Medical Bills Starts This Year!

As you’ve seen and probably know first-hand, for years, millions of Americans with medical emergencies often receive another nasty surprise: a bill from a doctor they did not choose and who did not accept their insurance. A law that went into effect the first of this year will make many such bills illegal.

Here’s what the new ban on surprise medical billing means for you…

The new year brings new protections for patients with private health insurance who will no longer be blindsided by “surprise” medical bills when they unknowingly receive out-of-network care.

It generally forbids insurers from passing along bills from doctors and hospitals that are not covered under a patient’s plan — such bills have often left patients to pay hundreds to tens of thousands of dollars in outstanding fees. Instead, the new law requires health care providers and insurers to work out a deal between themselves.

That means new billing protections when getting emergency care, non-emergency care from out-of-network providers, at in-network facilities and air ambulance services from out-of-network providers. Through new rules aimed to protect consumers, excessive out-of-pocket costs are restricted, and emergency services must continue to be covered without any prior authorization, and regardless of whether or not a provider or facility is in-network.

The Consolidated Appropriations Act of 2021 contains many provisions to help protect consumers from surprise bills, including the No Surprises Act under title I and Transparency under title II. Learn more about protections for consumers, understanding costs in advance to avoid surprise bills, and what happens when payment disagreements arise after receiving medical care.

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Resources:

https://newrepublic.com/article/155334/grim-lottery-surprise-medical-bill-stories

https://www.pbs.org/newshour/health/americans-who-confronted-surprise-medical-bills-share-their-stories

https://www.nytimes.com/2021/12/30/upshot/medical-bill-ban-biden.html#:~:text=When%20health%20policy%20experts%20discuss,whom%20patients%20didn’t%20choose.&text=But%20it%20is%20still%20not,what%20insurance%20plans%20will%20cover.

https://www.npr.org/sections/health-shots/2021/10/14/1045828215/ban-on-surprise-medical-bills

https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills

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